After Menopause, women begin to lower their levels of estrogen and progesterone. It has been shown that this along with other factors increases the risk of cardiovascular disease. For this reason, the Hormone Replacement Therapy (HRT) has been proposed as a means to counteract this hormone drop.
Many studies have been carried out to see if hormone replacement therapy actually has any beneficial effects on cardiovascular diseases. One of the best-known studies was conducted by the Women’s Health Initiative (Initiative for Women’s Health) which compared the effects of a combination therapy of estrogen and progesterone with the administration of a estrogen therapy alone. The study had to be suspended because of an increased risk of breast cancer as a result of the experimental treatments.
The risk of myocardial infarction in diabetic middle-aged women equals the risk of non-diabetic women who have had a previous cardiac attack. The protective effect against cardiovascular associated with sex hormones observed in non-diabetic women before menopause is absent in women with Type 2 Diabetes.
The risk of suffering a heart attack may not only be caused by Diabetes, other risk factors include obesity, the presence of atherosclerosis (hardening of blood vessel walls and the presence of fatty plaque in the arteries), high levels of blood fats and cholesterol, and a sedentary lifestyle.
Multiple studies have been carried out to assess the cardiovascular protection derived from HRT, but most of them were focused on healthy women and only few in diabetic women. Nevertheless, some authors have shown that HRT may be more effective in preventing heart disease compared to the standard treatment for this condition. The key here would be the early protective action presumably induced by the HRT.
Recent studies have shown that the HRT has favorable effects on blood lipids producing a decrease in total cholesterol and LDL (bad cholesterol) and an increase in HDL (good) cholesterol in women with or without Diabetes. However studies in diabetic women have shown that the HRT can increase triglycerides in blood while reducing the glycosylated hemoglobin levels. For this reason, blood lipids should be monitored before and after initiating the HRT treatment. If the patient has high blood lipid levels prior to the HRT treatment, he should be treated before starting the hormonal treatment.
It has also be shown HRT treatment can slow down the progression of atherosclerosis. Other studies have shown that diabetic women treated with HRT may benefit from a protective effect on their blood vessels.
Diabetic women during menopause experience changes in their bodies which are similar to those observed in non-diabetic women therefore, the use of HRT shares similar indications and contraindications in both diabetic and non-diabetic women. Despite this, it is important to be aware that the decision to use this treatment is personal and it should be discussed with the attending physician taking into account the possible benefits and risks. An early treatment start should also be discussed to increase the odds of achieving good results.